Provider Demographics
NPI:1780681684
Name:ARNOLD, TERRY J (PA-C)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SOUTH YORKTOWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-0000
Mailing Address - Country:US
Mailing Address - Phone:918-712-8888
Mailing Address - Fax:918-712-8892
Practice Address - Street 1:1516 SOUTH YORKTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-0000
Practice Address - Country:US
Practice Address - Phone:918-712-8888
Practice Address - Fax:918-712-8892
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003295363A00000X
OK1458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1000000350BMedicaid
GA97WCDQQMedicare ID - Type Unspecified
GA1000000350BMedicaid